This professor and medical superintendent of the Visakhapatnam-based Government Hospital for Mental Care (GHMC) has just become the first psychiatrist from Andhra Pradesh to be elected general secretary of the Indian Psychiatric Society (IPS). In an interview with Sulogna Mehtaof TOI, Dr N N Raju throws light on the new Mental Healthcare Bill under consideration, the debatable issue of Electro-Convulsive Therapy, medical opinion about homosexuality which can have a bearing on the future of Article 377 that criminalizes homosexuality, and the societal and lifestyle changes triggering psychiatric ailments.
What are the highlights of the new Mental Healthcare Bill under consideration?
The Bill appears to be more complex. Under this, even general hospitals will have to take permission of a mental health review commission (MHRC) to treat physical ailments of patients displaying psychological abnormality. Earlier, psychiatrists used to decide on admission of a patient in the mental hospital under the instruction of a magistrate. As per the new Bill, a five-member MHRC, comprising just a single psychiatrist, judicial members, counsellors and psychologists, will decide and can override the sole psychiatrist. There’s also provision of advanced directive, whereby a person can give directions to the commission on the mode of treatment he or she would like to undergo if they become mentally ill in future. Decriminalizing suicide is a good move. However, the Bill is mum on who will finance the various programmes — states or Centre. Changes in administration of Electro-Convulsive Therapy (ECT) or shock treatment are other areas it addresses.
Should ECT be banned for minors and be administered only under general anesthesia as the new bill suggests?
It’s a non-scientific decision to ban ECT for those below 18 years as the efficacy and safety of the 80-year-old practice has been proved even on children. Also, as per the new Bill, ECT has to be administered only under general anesthesia, which would increase the financial burden on the government as well as enhance the risk factor. There’s already a severe dearth of anesthetists in India. Also, without anesthesia, the mortality risk was just one in one lakh patients, while under anesthesia it will go up to one in 10,000.
Is homosexuality a disease or criminal offence?
Homosexuality is a grey area, entailing confusion and complexity, and black and white comments can’t be made on it. Globally doctors are divided on whether to label it normal or a deviation from the norm as genetics, environment and peer pressure contribute to it. However, homosexuals are not criminals, even though legally or morally they are considered wrongdoers. As of now, the IPS, consisting of around 5,000 registered psychiatrists, is working on finding out the majority opinion among psychiatrists regarding the classification and management of homosexuality.
What does forensic psychiatry entail?
Forensic psychiatry entails criminal and civil responsibilities. For instance, if a person with a mental illness commits a crime he can’t always escape the law citing the illness as a ground. He can be exempted from punishment only if he commits the crime without knowing what he was doing and without realizing the consequences of his act at the time of committing it. Civil responsibility refers to the capacity of such a patient to stand witness at a trial or write a ‘will’.
Are criminal minds wired differently?
It’s said that those displaying anti-social behaviour have a different brain structure and different kinds of neuro-chemicals work in the brain. Genetic predisposition also plays a role. However positron emission tomography (PET) scan done on criminals have been inconclusive and is still under research.
Why are mental ailments and juvenile crimes increasing in India?
Stress and lifestyle related diseases have gone up and as a result depression too. Breakdown of joint families and the lack of a trustworthy support mechanism along with lack of value education have aggravated problems, including anti-social behaviour among youngsters due to unfiltered exposure to internet and television.
Have social networking sites like Facebook and Twitter brought people closer or isolated them even more?
Online posts are more often not the true reflections of the feelings of individuals as people put up lot of inhibitions and pretences in the virtual world. True emotional exchange can take place only with real people and not on FB. It rather isolates people and the forced display of private emotions gives rise to depression in some or enhances the propensity to commit crimes, especially among youngsters.
Unlike abroad, a visit to a shrink or mental hospital is still stigmatized in India. Why?
The stigma is more to do with literacy and financial status of the individual. In India, mental ailments are associated with possession of evil or the consequence of sin or a curse due to illiteracy and hence stigma is more.
What will be your focus as IPS general secretary?
We will urge the government to focus on proper implementation of the National Mental Health Programme so that it benefits the grassroots. We are trying to convince the Medical Council of India to include psychiatry as a major academic subject in MBBS as it is currently clubbed with ‘medicine’. With one-third of physical ailments coming to general hospitals actually associated with some kind of psychiatric or psychological complications, general physicians or doctors of other disciplines also need to be trained in certain basic aspects of psychiatry. We are also trying to get mental ailments covered under some insurance scheme as well.
What is needed for the overall improvement of GHMC? Does Andhra require more mental hospitals in addition to the existing two in Vizag and Hyderabad?
We need medicines and manpower. The dearth of manpower, especially class IV staff and paramedics, is a serious cause of concern at GHMC. We would also need anesthetics facility if ECT under general anesthesia is made mandatory and new equipment like magnetic electro-therapy can be introduced in the government set-up. Rather than spending crores of rupees on new hospitals, the existing medical colleges and area hospitals should be strengthened in the districts with good infrastructure and manpower to treat mental disorders.
What about controversies surrounding clinical trials at GHMC?
Clinical trials are a must for any drug. There are guidelines but they should be more well-defined. Besides consent from legally acceptable relatives, the patient should be able to certify after understanding the nuances of the clinical trial and only then it should be conducted on him/her. Right now, no trials are underway at GHMC or the mental hospital in Hyderabad. Due to internal politics in government hospitals, such controversies and allegations are usually made.
What are the medical advancements in the treatment of severe psychiatric conditions like schizophrenia, bipolarism and acute depression?
There’s focus now on genetic engineering to know the wiring of the brain. Magnetic electro therapy, where magnetic waves are passed through the brain instead of electric shocks, is another new area of treatment and is less damaging. Newer and advanced drugs with fewer side effects are also being introduced.
source: http://www.timesofindia.indiatimes.com / The Times of India / Home> City> Visakhapatnam / by Sulogna Mehta, TNN / February 03rd, 2014